Why I Went to Liberia

Why I Went to Liberia

 {Photo credit: Fred Hartman/MSH}Dr. Logan and two women Ebola survivors at Annex 3.Photo credit: Fred Hartman/MSH

Tuesday, November 4, was my first day back at MSH headquarters since returning from Liberia nearly three weeks ago on October 21. I volunteered to go to Liberia—one of three West African countries at the center of the Ebola outbreak—because MSH has a wealth of experience to offer to help resolve one of the great public health challenges of our time. 

I started my career in smallpox eradication, and through the years have worked on other outbreaks: hemorrhagic fevers, SARS, avian and pandemic influenza, and multi-drug resistant tuberculosis (TB).  These diseases were—and are—highly infectious and carry significant mortality if proper infection control procedures are not followed.

The World Health Organization (WHO) reported Friday that of the total 13,268 confirmed, probable, and suspected cases of Ebola virus disease (Ebola), 4,960 people reportedly have died. Three West African countries overwhelmingly bear the Ebola outbreak burden: Guinea, Liberia, and Sierra Leone. Ebola is only spread by direct contact with sick patient secretions—not by casual contact. Ninety-nine percent of cases have been traced to a specific patient. You aren’t going to get Ebola standing in line in the airport. You aren’t going to get Ebola at a public place where an asymptomatic person has been.

Ebola is spread by the most essential of human emotions—caring for a patient or loved one who is ill. Health workers and family members—especially those at the epicenter of the outbreak in West Africa, with no running water or bathrooms—are at risk of getting Ebola when caring for a family member who is vomiting, having diarrhea, or coughing.

Meeting Dr. Logan and Ebola Survivors

Ninety percent of my activities in Liberia were meetings in large and small groups, but the day trips were most memorable. In Bomi County, two hours north of Monrovia, I linked up with Dr. Logan, chief medical officer for the hospital and county. From a distance of 25-30 feet, I accompanied Dr. Logan on his rounds as he spoke with patients suffering from the disease. He has been making these visits every day since March, and has not contracted Ebola.

Even before Liberia got cases, Dr. Logan had built in March a very rudimentary Ebola Community Care Center (CCC) with his own funds. The CCC consisted of two buildings made of cement blocks and tin roofs: One was a “wet” building—for people with vomiting, diarrhea, and bleeding. The second was designated the “dry” building for people with suspected Ebola, but no “wet” symptoms. From an earthen mound 1-2 feet high, Dr. Logan would talk with patients and health workers, who were wearing hazmat suits and personal protective equipment. A handmade picket fence 4-5 feet high encircled the buildings.

[Ebola Treatment Unit "wet" building.] {Photo credit: Fred Hartman/MSH.}Ebola Treatment Unit "wet" building.Photo credit: Fred Hartman/MSH.

[People with suspected Ebola, but no "wet" symptoms stay in the "dry" building.] {Photo credit: Fred Hartman/MSH}People with suspected Ebola, but no "wet" symptoms stay in the "dry" building.Photo credit: Fred Hartman/MSH

From this distance of 25-30 feet, we talked with Ebola patients in both buildings: “Hey, how are you doing? We’re with you—hang in there.” We could see them: they didn’t want to stay inside—it was so hot. And there were no trees to shade the buildings from the baking sun.

The so-called wet patients were just lying there. They couldn’t move, they were so sick. The dry patients didn’t move much, either. They were sitting on benches outside under a canopy.  They’d say, “Yeah, we’re ok. Fine, thank you.”

I talked with a doctor and one other patient outside the dry building. They appeared fine at the time. I learned they both later died.

We moved along and talked with a group of Ebola survivors—all women. Having survived and recovered from Ebola, the women were immune and didn’t have to wear protective garments. They were taking care of patients: carrying water in on their heads, feeding the patients, and comforting them.

I lagged behind. I wanted to ask the survivors about their experiences. They were part of a cohort being treated with an antiretroviral named almivudine—of the first 15 cases, 13 have survived. They said they had been really sick; that the disease is extremely painful with explosive vomiting and diarrhea.

Why did they survive? I asked. “God first, medicine second,” one woman said. Several women hugged Dr. Logan. They considered him their savior. The women said they feel that taking care of patients was their duty.

MSH has mobilized our Ebola preparedness and response efforts in Liberia and surrounding countries. It is an honor and privilege to participate in these response activities with our international and local colleagues, and to meet people like Dr. Logan and the cohort of survivors. If you’d like to learn more about opportunities to partner with us on Ebola, please contact me.

[Ebola survivors helping care for patients.] {Photo credit: Fred Hartman/MSH}Ebola survivors helping care for patients.Photo credit: Fred Hartman/MSH